HomeMy WebLinkAboutPermit Mechanical 1980-11-20
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I INSPECTION LHlE..... r- CIn UF SPRINGFlELD' '
726-3769 .~~ ~Q..... S'S'J.., C0I1BIHATlON APPLICATION/PERMIT
Job Address '1 T. ~"" M.a in .:;)fruf \ ~~;~f..~~~CES:
Legal Description i1-0~-_~-1- ,", i,later Heater '^leA
/ -m Ran~e VI. (0..
~ ValuE of Work:
o CE ""\. L ..... I '"' ",ODO. o.g
wner -..lOI'lVl . ( Ii> xlf' 11~W\O All 't" ~ - ,..,
Builtino Permit Info: Describe l~ork{Le., Build Single
Address 7;Z~3 N E \~O,:Z"-\ . I -+.\IP. Phone Familv Residence Hith Attached GaraDe)
\f(lV\rF'l\III......:;~h..~V'I('1+r'''' /Z5..LYJD R1u Rdut"J<lVlf ~
Construction Lender V /~ 000 .R7IJ ~U5pf'.Yl/lpr/ - ;'
Address Phone . (~vt'r Vacant lease. 5.pa..ces {! Ca.~.0p)
Ul:.~l(]fl nAH (name) (address) flies. no.) (exoires) {ohane no..~
~~~
-=--,,;, !
lNFORllATION liNt
726-3753
Sq. Ft~. 1,Iain
~q. Ftg. Access.
Sq, Ftg. Other
flew Add A Her Pep,
-Fence Demo Change/Use
V'!Jther 0/.(>, IIIO.Y' i (n. l
r-l
-0
U\
~
Primary
Structural
Electrical
.l ('if " lA' /) d'L' . 7zo<t 1'tE' 71'OJ::s,~
11echanical CenTro. eu..1/f\QZ, ~ II" LDV\ IrLD'^iV\.Q- V",,^,Ol'WV- lA/l\~
CONTRACTORS (name ~ (address"Y . ... (Hr.s. no.)
General C€ "Soh.V\ c-''''''''~\nl/'+;()V\- 72.'L3 N~ Ho.u.\ ~\ Ave..-
WClsn\~-ro~
(exoir~s)
:l.$Io-/I.Jfol
(ohone no.)
(5D3 \ ?R~-.""::V~5'
Plumbina
Electrical
L_ f' lA' '1." 720'1 f\le ";;J"5tv<-,,,i-
~lechanic'aleallYlAI !-ka. r"'j~ II" G:,1'Id\ rlOt1.I "g- Xl'''^'''''''''D'~" \^Jncc,^_
PLUI1BIIIG ELECTRICAL
2.510 -I '-I to I
MECHANICAL
NO. I
Each single fixture
I FEF I r.HARGF
NO
11='1="1=" I r~AI:U;:1=" NO.
11='1="1=" I rl-IAQr.1="
Residence of
SQ. FT. I
furnace/burner to
/.i/5.LXJI"J BTU's
7"so
Relocated building
(new fix, additional)
New circuits alts.
or extensions
fluUI fNrRace
S.F. Residence
(] bath)
Ouplex (1 bath) each
Additional bath
SERVICES
/ 156;t:Jo:! !PrlJ's.
Recessed wall
Sn;r.rp h,p-"tpr ;lonrl I/Qnt
7.St)
Storm Sewer
Of
amps.1
Appliance vent
seOilriltl'>
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood ilnd dULt
Sewer
Temporary Construction
Change in existing
res.irle.nr:p'
multifamily, corrm. or
Industriill
~Iater service
I
I
I
CDII:!. 1- </OvTt.e7S.1
I
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~.OO'
COI1I'1. II ND. FEEDERS
I Install/alter/relocate
rli"t.rih_ fppfipr.;.
IOf amps.1
I
I
I ISSUANCE OF PFRI1lT /O,()f)
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES ..:J'1.D"l
WHERE STATE L~H REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Wood stove/heater
I HAVE CAREFULLY EXMlINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n, and that HO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by DRS 701.055, that if ~xempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IWIE(please print)/"'P'_II ~ ~~ SIGilATURE
- . - - ~FO~ OFFICE USE DIlLY
Type/Canst. Units Sq. Ftg. riain
Bedrooms Occy load Sq. FtQ. Access
Stories Occy Group Sq. Ftg. Other
DATJ/ -d (J -;;7
Zone
Fi re Zone
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATIOtI
BUILDING PERmT
Charges and
Surcharges .
Plan Ck. Comm/lnd
65%/Bldo Ppr I=I'>€'
Plan Ck. Res
30%/BldD Per Fee
Systems Development
CharDe (1.5%) ,
PLUt1BlNG PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICAL PERI~IT 'Sidewa 1 k
Charges and ------------
Surcharges A/C Paving
I
I1ECHAN I CAL PERMIT
. Charges and
Surcharges
'___hhQl~~1 Curb Cut
l.tJ~ "
......-... .. >>,,-,',-,,"'.. ~~ ,.,.-..,.. .......;..~ .........."'.......-
I
I
,
Irotal Comb. Permit
,I TOTAL ~ J ~. tJ~
~....~..__.__...............-- ........,.-................'_....""". '\,n-:<;"7:'>"
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.................w, . . '..~.'.. .
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COMBINATION APPLICATION/PERMIT (CAP)
.
I. Applicant to furnish
A. Job Address ,
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
I7 oj 43
2, exam~le- Lot L Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceili~q/or forced' air qas
2. exampJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
a ttached garage
2. example. remodel .existing garage into family room
3. exa~le - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code .l'
H. DESIGN TEfu~ AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill~in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label. ---
Ill. Applicant to Sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V, FOR OFFICE USE ONLY-
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
"
PERMIT VALIDATION.
,
Permit Clerk
,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project: Information:
I
PLANS REVIEWED BY:
/12
name
signature
."f
I"
date /~/?-f?O
,I
Job Address ~":tr:!if I-t.a in .:5fva./
Legal De<cription /7-c);::(-_::s.3--<j..
. . I'
Non: Su-- i-{a.st~;- Pict-n fr' moi'~ 1'1J'o"nw.f{c~- r'
- .. . ~
CiT! OF SPRr:,GFiELD-
COIIBI;iATlON APPLlCATlON/PERI~IT
E"ERroy SOURCES:
Heat.~~(\"'~"
:!ater Heater "t"\,Io..
Phone
Ranoe. Y'\. iC4..
Value: of \.Jark:
, 00
A./.OOO. -
BuiltinQ Penult Info: Describe Horkl i-.e. 1 Build Single
Far.lilv rtes;dence Hith ~.ttached Garaqe)
/'J.5.,cx.-YJ B1u Rod' /..II~(IIII f &
I~ 000 RTi) :5US?t'J1r1f'r/ - '
(r:,w.v- VCUtJ.nt lease. :5fXlLe5 t.' Ca~va.$i1e.o)
flies. no.) (exnires) (ohone no. I'
!IIFDRlIATlON liNt
726-37S3
Sq. Ftg. r'iain
~q. Ftg. Access.
Sq_ Ftg_ Other
'Iew Add Alter Rep_
--Fence Demo Change/Use
V'Other M()'- "^":'~:..LGJ-
,
lri
--0
<.JJ
~
N
I WSPECTlOII L WE -r>-
726-3769 :~,-",,;:.q "'" <:;'."S"),L:;"'
, -.
OwnerCE --.'ldhlfl -"()p \1,. I r\ \__'^"" '^.\.
Address 7;Z:<3 N E i.lrc.:z"-.\ ;1-.. \ t~""
W . I
\Irlil'n)'lil~V-__ f\C,\-'I"'(,-,..,..,Y\
Construction lender"l . V
Cr>-
Address
Uc,llifl IcAII
lname)
Phone
(address)
Primary
Structural
Electrical
; , ,\, . . ' 72.QLj I'{E" 7i~:::,t\-ee.:,"
i~echanical Co!l'I1"yC\1 kf'.iltlftQt AI'r' C'O"ldi hDV\i\~o.- '1",.^.,~ ",,,1'. LA/nc.\II
CONTRACTORS (name),,/ (addrpss-...:y" -- - (1 fcs. no.)
General e € 3or..1'I C;.-.V\.J Ir'. 11'.\-;"\1\ - 72.'2.'3 N ~ t1<.:.U\ D:..l {Ave.-
wa.'S\'\\'^S1o,'"
(exoirps)
25 Ic-II./Io I
(ohonp nn )
(':;;03 ) 2R=<.-.""~,S-
Pl umb; nq
Electrical
, 'Iechanic'al Ccl'l+a:ti
. ." 'A' -, '., '120'1 l'IE1l ~ 5tn"-;,
Hmh.,qt trCc"dlt(OKliAO-- \In.M''''~\'"'~ \";n",,,_
~ 0. ~ .
ELECTRICAL
25fo -I'-{~ I
PLUiiBiIIG
MECHAIIICAL
110.
I FEE I (HAR(;E
NO I
Residence of
! ~q:' I rI-lARr,~
NO. I
I ~~~
I nHH?r.~
Each single fixture
SQ, FT.,
/
furnace/burner to
1';<5.=~) BTU's
7,SlJ
IRelocated building
(new fix. addition~l)
S.F. Residence
(1 hath I
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Ptocrr-fu-r:na.ce
/ and-vent ,
I /:1'[:J,r"}1~' BTa s.
Recessed wa 11
Sn~rp np~tp~ ~nn vpnt'
7.Sn
SERVICES
Storm Sel'ler
Of
amps,
Appliance vent
,c;eoar~tp
Stationarv evaD.
coolp.r ~ ,
Vent fan wi th
sinole duct
I Vent system apart
heatino or A.C.
Mechanical exhaust
hood ilnd rlur:t
Wood stove/heater
from
Sewer
Temporary Construction
Change in existing
rps i qJ'ni{>
multifamily. comm. or
InntJc;tri;:tl
~!a ter servi ce
COI~'I.IINO, FEEDERS
Install/alter/relocate
di~trih_ fpprlpr~
Of
amps.
/
Gt!~. 1- </Ourt.e7S
1,,7.0')'
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
ISSUANCf OF PFRillT
I TOTAL CHARGES , I TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of
label has been signed 9Y an Electr;cal Supervisor and returned to the Building Division
10,c-o
~1:7..-:n
this perTilit
I HAVE CAREFULLY EXNl WED the comp 1 eted ap!1 1 i ca ti on for permit. and do hereby cert ify tha tall in forma t i on hereon is true
and correct. and I further certify. that any and all work oerformed shall be done in accordance with the. Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the \...ork described herein. and that rlo OCCUPAUCY will be made
of any structure without the permission of the Building ~ivision, I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemotion is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project.
HAME(please print) (!:.-;Z; ~ .L..L-y_ , '" SIGilATURE
FO~ OFFiCE USE QilLY
Ii ~ 0 --,?,!
om:/ 1
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ftg.
Sq, FVJ.
Sq. Ftg,
/1ai"
Access
Other
x
x
x
Value
Value
Value
TOTft,L VALUATIDrI
BUILDING PERI,IIT
Charges anc
Surcharges
____________1 ~~~~R~~~ ~~~f;~d
Plan Ck. R'es
30%/81 do Per Fee
Fence
Systems Development
CharQe (LSn
PLUI,IBING PERMIT
Charges and
Surcharges
. Demo
I'Sidewal k
ELECTRiCAL PERI~IT
Cha rges and
Surcharges
A/C Paving
Total Comb, Permit
I
1>,4 ~ i. tJ<3
~
liECHAN I CAL PERMIT
. Charges and
S!:n:harl)es
\ -"
, _ _ _ _ h _~!J.!fXl Curb Cut
/.O~,
---I TOTAL
!
6ft."
.,..,..
CONBINATION APPLlCAilON/PERNIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. examole- Tax lot 100, lane County Map Refe
1I 03 43 ('.
2. example- Lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources (
1. examo 1 e- hea tf e 1 ectr; Cd 1 ceil i n%~~r forcee
2. examDle-' waterheater/electrlcallor solar
E. Square. footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq, foo ~ri
2. example- T71new project. check-new - if a
check add, etc.
F. Building permit information:
1. examole - construct single family house \'. ta-
d ttached garage
2. examole - remodel existing garage into fc:
3. examole - convert single family residenc!
res taurant (change of use) (
G. Value of work as defined in Section 303 (a) I
Structural Specialty Code
H. OESIGN TEAr'I ArlO CONTRACTORS
To avoid design or construction delays, Bull I..g
Division Staff must be able to contact appro' '..
persons regarding design information or job
corrections, etc.
II. Abbreviated Plumbing, Hechanical, & Electrical ~ ~lJ
A. Except where blank scaces occur in the descl ~
portion of the Mechanical and Electrical Scl
the applicant need fill-in only the No. Boxl
to the appropriate item(s) to be installed (
B. Full Plumbing, Nechanical. and Electrical S ,:.
are available at the Building Division
1. To conserve space on the permit form th
have been abbreviated
2. If the item(s) to be installed are not
the abbreviated schedules you should cc
full schedules
C. BUILOIlIG OIVISION STAFF WILL FILL OUT ALL I
CHARGES 011 THE SCHEOULES
D. As noted an the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application wil
a ~'Iorksheet only. Where possible, Building Di '11..
will prepare a type written copy and return if (~
applicant at the time the actual permit is is~
signature.
Fees and Charges
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
fees are paid. Al.l other fees and charges are due and
payable when the permit is issued.
be del
by his
is not
e
. ,Amount
III.
<n'
C "'
's
'".
1'1.
'I. FOR OFFICE USE ONLY.
,~
f PFRMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield. Oregan
Department of Public Warks
OFFICIAL RECEIPT '
(9
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Date, ~~") . r{)O 1~) No. B
'~"'o.r:.I, {\ tlIl\ U \\ ~ 1\""fP
Address~ aLA fI'~ \ \'* I ~ ( l
Received For:
r
I,
,-tGQ62H
AfJ)
{~~ot:N
IJPIr,
!J0CO
( ,0'8 (
L ~ .00 (
. ''l/J'
/I){J, -50 (
(}<{;
I. J'{\ QJ' H
49'^
~
(
Received
ror L C?<::)
I -
l'1'Ufr" (
\
)
(
,
lu.a..r 0".'.0'
5.."..
(
(
I
Permi t Cl erk
_ _. .. ... .... .0. _0 ~ . _ _.. .... .. MO..~~....-.....:, ....... ._. .. ..,~ '._' ..,..
J
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,_...",......' ._.... ''''.0'_' _..,. .. uo '......,
/12
dat~ /~/7-g-0
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